CC BY 4.0 · European J Pediatr Surg Rep. 2020; 08(01): e27-e31
DOI: 10.1055/s-0039-1695048
Case Report
Georg Thieme Verlag KG Stuttgart · New York

A Surgical Technique to Repair Perineal Body Disruption Secondary to Sexual Assault

1   Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Marc A. Levitt
2   Department of Colorectal and Pelvic Reconstructive Surgery, Children’s National Hospital, Washington DC, United States
Richard J. Wood
3   Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
Christopher J. Westgarth-Taylor
1   Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
› Author Affiliations
Further Information

Publication History

27 June 2019

08 July 2019

Publication Date:
28 April 2020 (online)


Perineal trauma is uncommon in the pediatric population and it is estimated that 5 to 21% is secondary to sexual abuse. We aim to present a proposed surgical technique to repair perineal injuries secondary to sexual assault in female children. The technique is based on the posterior sagittal anorectoplasty (PSARP) for repairing anorectal malformations and, between 2017 and 2019, it was used to treat three girls (2 months, 2 years, and 8 years of age) with fourth-degree perineal injuries secondary to sexual assault. One of them underwent laparotomy and Hartmann's colostomy for an acute abdomen. Two underwent wound debridement and suturing and only had a stoma fashioned at 5 days and 6 weeks posttrauma, respectively. The perineal repair was performed 2, 6, and 7 weeks postinjury and done as follows: with the child prone in jack-knife position, stay-sutures are placed on the common wall between the rectum and the vagina. Using a needle tip diathermy, a transverse incision is performed below the sutures lifting the anterior rectal wall up. Stay sutures are then positioned on the posterior wall of the vaginal mucosa. The incision between the walls is deepened until the rectum and the vagina are completely separated. The deep and superficial perineal body is then reconstructed using absorbable sutures and an anterior anoplasty and an introitoplasty are performed. The stoma in each was closed 6 weeks postreconstruction. At follow-up, now 1 year or more postrepair, all patients have an excellent cosmetic outcome and are fully continent for stools.

  • References

  • 1 Onen A, Oztürk H, Yayla M, Basuguy E, Gedik S. Genital trauma in children: classification and management. Urology 2005; 65 (05) 986-990
  • 2 Janssen TL, van Dijk M, Al Malki I, van As AB. Management of physical child abuse in South Africa: literature review and children's hospital data analysis. Paediatr Int Child Health 2013; 33 (04) 216-227
  • 3 Scheidler MG, Schultz BL, Schall L, Ford HR. Mechanisms of blunt perineal injury in female pediatric patients. J Pediatr Surg 2000; 35 (09) 1317-1319
  • 4 Russell KW, Soukup ES, Metzger RR. , et al. Fecal continence following complex anorectal trauma in children. J Pediatr Surg 2014; 49 (02) 349-352
  • 5 Bakal U, Sarac M, Tartar T, Cigsar EB, Kazez A. Twenty years of experience with perineal injury in children. Eur J Trauma Emerg Surg 2016; 42 (05) 599-603
  • 6 Patterson D, Hundley AF. Risk factors for perineal lacerations in teen deliveries. Female Pelvic Med Reconstr Surg 2010; 16 (06) 345-348
  • 7 Shveiky D, Patchen L, Chill HH, Pehlivanova M, Landy HJ. Prevalence and location of obstetric lacerations in adolescent mothers. J Pediatr Adolesc Gynecol 2019; 32 (02) 135-138
  • 8 Sham M, Singh D, Wankhede U, Wadate A. Management of child victims of acute sexual assault: Surgical repair and beyond. J Indian Assoc Pediatr Surg 2013; 18 (03) 105-111
  • 9 Hashish AA. Perineal trauma in children: a standardized management approach. Ann Pediatr Surg 2011; 7 (02) 55-60
  • 10 Ekenze SO, Nwagha UI, Ezomike UO, Obasi AA, Okafor DC, Nwankwo EP. Management of sexual assault-related large rectovaginal fistula in an eight-year-old. J Pediatr Adolesc Gynecol 2011; 24 (02) e39-e41
  • 11 Jenny C, Crawford-Jakubiak JE. ; Committee on Child Abuse and Neglect; American Academy of Pediatrics. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics 2013; 132 (02) e558-e567
  • 12 Wiersma R. HIV-positive African children with rectal fistulae. J Pediatr Surg 2003; 38 (01) 62-64 , discussion 62–64
  • 13 Levitt MA, King SK, Bischoff A, Alam S, Gonzalez G, Pena A. The Gonzalez hernia revisited: use of the ischiorectal fat pad to aid in the repair of rectovaginal and rectourethral fistulae. J Pediatr Surg 2014; 49 (08) 1308-1310